Provider Demographics
NPI:1578565743
Name:KILEY, THOMAS EVERETT (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EVERETT
Last Name:KILEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0656
Mailing Address - Country:US
Mailing Address - Phone:231-775-1357
Mailing Address - Fax:231-775-4709
Practice Address - Street 1:9116 E 13TH ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8126
Practice Address - Country:US
Practice Address - Phone:231-775-1357
Practice Address - Fax:231-775-4709
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITK004039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H350120OtherBCBS
MI143066839Medicaid
MIU25890Medicare UPIN
MIOH35012Medicare ID - Type Unspecified